Provider Demographics
NPI:1396752606
Name:CASTELLANI, JOHN ROBERT (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:CASTELLANI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1725
Mailing Address - Country:US
Mailing Address - Phone:716-285-1904
Mailing Address - Fax:716-284-8262
Practice Address - Street 1:419 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1725
Practice Address - Country:US
Practice Address - Phone:716-285-1904
Practice Address - Fax:716-284-8262
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0717481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000528407001OtherTRADITIONAL SECURE BLUE
NY01465154Medicaid
000528407001OtherBCBS WNY
000528407001OtherFAMILY HEALTH PLUS
000528407001OtherHMO 100
000528407001OtherCHILD HEALTH PLUS
000528407001OtherCOMMUNITY BLUE
000528407001OtherCB ADVANTAGE
000528407001OtherCHILD HEALTH PLUS